Civil Engineering Reference
In-Depth Information
Appendix 10.1
Example personal emergency evacuation plan questionnaire for
disabled staff
PERSONAL EMERGENCY EVACUATION PLAN QUESTIONNAIRE FOR DISABLED STAFF
NAME
________________________________________________________________________________________________
JOB TITLE
________________________________________________________________________________________________
DEPARTMENT
________________________________________________________________________________________________
BRIEF DESCRIPTION OF DUTIES
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
LOCATION
1.
Where are you based for most of the time while at work?
2.
Will your job take you to more than one location in the building in which you are based?
YES
NO
3.
Will your job take you to different buildings?
YES
NO
AWARENESS OF EMERGENCY EGRESS PROCEDURES
4.
Are you aware of the emergency egress procedures that operate in the building/s in which you work?
YES
NO
5.
Do you require written emergency egress procedures?
YES
NO
5a
Do you require written emergency procedures to be supported by British Sign Law interpretation?
YES
NO
5b
Do you require the emergency egress procedures to be in Braille?
YES
NO
5c
Do you require the emergency egress procedure to be on tape?
YES
NO
5d
Do you require the emergency egress procedures to be in large print?
YES
NO
6.
Are the signs which mark the emergency exits and the routes to the exits clear enough?
YES
NO
EMERGENCY ALARM
7.
Can you hear the fi re alarm/s provided in your place/s of work?
YES
NO
DON'T KNOW
